颈浅丛神经阻滞联合瑞芬太尼加丙泊酚全麻在喉返神经监测甲状腺手术中的应用

Application of Superficial Cervical Plexus Block Combined with Remifentanil and Propofol for Thyroidectomy under Intraoperative Recurrent Laryngeal Nerve Neuromonitoring

目的探讨双侧颈浅丛神经阻滞联合瑞芬太尼＋丙泊酚全麻在行喉返神经监测甲状腺手术中的临床应用。方法 ASAⅠ~Ⅱ级择期行喉返神经监测的甲状腺手术60例,随机均分为观察组（J组）和对照组（R组）。J组行双侧颈浅丛一点法阻滞,两侧分别注入0.375%罗哌卡因12ml,而后两组均采用全麻药复合罗库溴铵0.3mg/kg快速诱导,插入神经监测特制导管。术中不用肌松药,泵注瑞芬太尼＋丙泊酚维持麻醉。记录不同时间点BIS,MAP,HR值;记录睁眼时间、拔管时间、术后疼痛及丙泊酚和瑞芬太尼的用量;记录神经监测：V_1,R_1,R_2,V_2值。结果 J组T_1,T_3,T_4时MAP低于R组,HR慢于R组（P〈0.05）;J组神经监测数值V_1,R_1,R_2,V_2略高于R组（P〉0.05）;术毕清醒和拔管时间J组明显短于R组（P〈0.05）,术后4h疼痛VAS评分J组明显低于R组（P〈0.05）;J组丙泊酚和瑞芬太尼用量明显少于R组（P〈0.05）。结论双侧颈浅丛神经阻滞联合瑞芬太尼＋丙泊酚全麻,能保证甲状腺神经监测术顺利实施,且麻醉用药量少,术后疼痛轻。

Objective To investigate the clinical application of bilateral Superficial cervical plexus block combined with remifentanil and propofol for thyroidectomy under intraoperative recurrent laryngeal nerve neuromonitor- ing. Methods Sixty thyroidectomy patients （ ASA classification of physical status ： class I - Ⅱ ） were randomly divided into 2 groups：group J blocked superficial cervical plexus with 12ml 0. 375 % ropivacaine bilaterally, group R { the control group）. Both groups used rocuronium 0.3mg/kg for induction of general anesthesia, intravenous infusing remifentanil and propofol was applied to maintain anesthesia without muscle relaxants. BIS, MAP, HR of different time, the time of open eyes, exintubation, visual analogue score （ VAS ） after operation, dose of propofol and remifentanil, value of V1 , V2 , R1 , R2 from nerve neuromonitor were all recorded. Results MAP and HR of Group J from T1 ,T3 and T4 were either less or slo- wer than that of Group R correspondingly （ P 〈 0.05 }. Larger V1, V2, R1, R2 were recorded for Group J （ P 〉 0.05 ）. A smaller dose of propofol and remifentanil were used for Group J, it showed shorter time for completely awake and exintu- bation after operation （ P 〈 0.05 ）. Conclusion Bilateral superficial cervical plexus block combined with remifentanil and propofol for general anesthesia can meet the demand of operation, needs a smaller dose of drug, and it has the advan- tages of less pain ＇after operation without obviously influence for intraoperative neuromonitoring.